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Comparison of Spectral Entropy and BIS VISTA™ monitor during general anesthesia for cardiac surgery

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Abstract

Objectives

We compared the primary metrics of the Spectral entropy M-ENTROPY™ module and BIS VISTA™ monitor—i.e., bispectral index (BIS), state entropy (SE), and response entropy (RE) in terms of agreement and correlation during general anesthesia for cardiac surgery. We also evaluated responsiveness of electroencephalogram (EEG)-based and hemodynamic parameters to surgical noxious stimulation, skin incision, and sternotomy, hypothesizing that RE would be a better responsiveness predictor.

Methods

BIS and entropy sensors were applied before anesthesia induction in 32 patients having elective cardiac surgery. Total intravenous anesthesia was standardized and guided by the BIS index with neuromuscular blockade tested with train-of-four monitoring. Parameters included SE, RE, BIS, forehead electromyography (EMG), and hemodynamic variables. Time points for analyzing BIS, entropy, and hemodynamic values were 1 min before and after: anesthesia induction, intubation, skin incision, sternotomy, cannulation of the aorta, cardiopulmonary bypass (CPB), cross-clamping the aorta, de-clamping the aorta, and end of CPB; also after starting the re-warming phase and at 10, 20, 30, and 40 min following.

Results

The mean difference between BIS and SE (Bland–Altman) was 2.14 (+16/− 11; 95% CI 1.59–2.67), and between BIS and RE it was 0.02 (+14/− 14; 95% CI 0.01–0.06). BIS and SE (r 2 = 0.66; P = 0.001) and BIS and RE (r 2 = 0.7; P = 0.001) were closely correlated (Pearson’s). EEG parameters, EMG values, and systolic blood pressure significantly increased after skin incision, and sternotomy. The effect of surgical stimulation (Cohen’s d) was highest for RE after skin incision (−0.71; P = 0.0001) and sternotomy (−0.94; P = 0.0001).

Conclusion

Agreement was poor between the BIS index measured by BIS VISTA™ and SE values at critical anesthesia time points in patients undergoing cardiac surgery. RE was a good predictor of arousal after surgical stimulation regardless of the surgical level of muscle relaxation. Index differences most likely resulted from different algorithms for calculating consciousness level.

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References

  1. Leslie CJ, Sloan TD. Using the EEG to monitor anesthesia drug effects during surgery. J Clin Monit Comput. 2006;20:445–72.

    Article  Google Scholar 

  2. Freye E, Levy JV. Cerebral monitoring in the operating room and the intensive care unit: an introductory for clinician and guide for the novice wanting to open a window to the brain. J Clin Monit Comput. 2005;19:1–76.

    Article  PubMed  Google Scholar 

  3. Viertiö-Oja H, Maja V, Särkelä M, Talja P, Tenkanen N, Tolvanen-Laakso H, Paloheimo M, Vakkuri A, Yli-Hankala A, Meriläinen P. Description of the Entropy™ algorithm as applied in the Datex-Ohmeda S/5™ Entropy Module. Acta Anaesthesiol Scand. 2004;48:154–61.

    Article  PubMed  Google Scholar 

  4. Lefoll-Masson C, Fermanian C, Aimē I, Verroust N, Taylor G, Laloë PA, Liu N, Aegerter P, Fischler M. The comparability of bispectral index and state entropy index during maintenance of sufentanil-sevoflurane–nitrous oxide anesthesia. Anesth Analg. 2007;105:1319–25.

    Article  PubMed  CAS  Google Scholar 

  5. Bonhomme V, Deflandre E, Hans P. Correlation and agreement between bispectral index and state entropy of the electroencephalogram during propofol anaesthesia. Br J Anaesth. 2006;97:340–6.

    Article  PubMed  CAS  Google Scholar 

  6. Tiren C, Anderson RE, Barr G, Öwall A, Jakobsson JG. Clinical comparison of three different anaesthetic depth monitors during cardiopulmonary bypass. Anaesthesia. 2005;60:189–93.

    Article  PubMed  CAS  Google Scholar 

  7. Lehman A, Schmidt M, Zeitler C, Kiessling A-H, Isgro F, Boldt J. Bispectral index and electroencephalographic entropy in patients undergoing aortocoronary bypass grafting. Eur J Anaesthesiol. 2007;24:751–60.

    Article  Google Scholar 

  8. Meybohm P, Gruenewald M, Höcker J, Renner J, Graesner J-T, Ilies C, Scholz J, Bein B. Correlation and agreement between the bispectral index vs. state entropy during hypothermic cardio-pulmonary bypass. Acta Anaesthesiol Scand. 2010;54:169–75.

    Article  PubMed  CAS  Google Scholar 

  9. Baulig W, Seifert B, Schmid ER, Schwarz U. Comparison of spectral entropy and bispectral index electroencephalography in coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth. 2009;24:544–9.

    Article  PubMed  Google Scholar 

  10. Musialowicz T, Niskanen M, Yppärilä-Wolters H, Pöyhönen M, Pitkänen O, Hynynen M. Auditory-evoked potentials in bispectral index-guided anaesthesia for cardiac surgery. Eur J Anaestesiol. 2007;24:571–9.

    Article  CAS  Google Scholar 

  11. Sleigh JW, Leslie K, Voss L. The effect of skin incision on the electroencephalogram during general anesthesia maintained with propofol or desflurane. J Clin Monit Comput. 2010;24:307–18.

    Article  PubMed  Google Scholar 

  12. Wheeler P, Hoffman WE, Baughman V, Koeing H. Response entropy increases during painful stimulation. J Neurosurg Anesthesiol. 2005;17:86–90.

    Article  PubMed  Google Scholar 

  13. Weil G, Passot S, Servin F, Billard V. Does spectral entropy reflect the response to intubation or incision during propofol–remifentanil anesthesia? Anesth Analg. 2008;106:152–9.

    Article  PubMed  CAS  Google Scholar 

  14. Liu N, Chazot T, Huybrechts I, Law-Koune J-D, Barvais L, Fischler M. The influence of a muscle relaxant on bispectral and Datex-Ohmeda entropy values during propofol-remifentanil induced loss of consciousness. Anesth Analg. 2005;101:1713–8.

    Article  PubMed  CAS  Google Scholar 

  15. Baughman VL, Hoffman WE, Koenig HM, Wheeler PL, Ananda RC, Wang M. Recovery from paralysis with succinylcholine increased response entropy and EMG but not the state entropy. J Clin Monit Comput. 2005;19:201–5.

    Article  PubMed  Google Scholar 

  16. Illman H, Antila H, Olkkola K. Reversal of neuromuscular blockade by sugammadex does not affect EEG derived indices of depth of anesthesia. J Clin Monit Comput. 2010;24:371–6.

    Article  PubMed  Google Scholar 

  17. Rampil IJ. A primer for EEG signal processing in anesthesia. Anesthesiology. 1998;89:980–1002.

    Article  PubMed  CAS  Google Scholar 

  18. Vakkuri A, Yli-Hankala A, Talja P, Mustola S, Tolvanen-Laakso H, Sampson T, Viertiö-Oja H. Time–frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia. Acta Anaesthesiol Scand. 2004;48:145–53.

    Article  PubMed  CAS  Google Scholar 

  19. Ranta SO-V, Herranen P, Hynynen M. Patients’ conscious recollections from cardiac anesthesia. J Cardiothorac Vasc Anesth. 2002;16:426–30.

    Article  PubMed  Google Scholar 

  20. Bonhomme VL, Hans PC. Bispectral index and state entropy of the electroencephalogram during propofol anaesthesia (letter). Br J Anaesth. 2007;98:145–6.

    PubMed  Google Scholar 

  21. Hamilton C, Stamey J. Using the Bland–Altman to assess agreement between two medical devices–don’t forget the confidence intervals!. J Clin Monit Comput. 2007;21:331–3.

    Article  PubMed  Google Scholar 

  22. Iannuzzi M, Iannuzzi E, Rossi F, Berrino L, Chiefari M. Relationship between Bispectral Index, electroencephalographic state entropy and effect-site EC50 for propofol at different clinical endpoints. Br J Anaesth. 2005;94:492–5.

    Article  PubMed  CAS  Google Scholar 

  23. Feld J, Hoffman W, Park H. Response entropy is more reactive than bispectral index during laparoscopic gastric banding. J Clin Monit Comput. 2006;20:229–34.

    Article  PubMed  Google Scholar 

  24. Vanluchene ALG, Struys MMRF, Heyse BEK, Mortier EP. Spectral entropy measurement of patient responsiveness during propofol and remifentanil. A comparison with the bispectral index. Br J Anaesth. 2004;93:645–54.

    Article  PubMed  CAS  Google Scholar 

  25. Hans P, Giwer J, Brichant JF, Dewandre P-Y, Bonhomme V. Effect of an intubation dose of rocuronium on Spectral Entropy and Bispectral Index™ responses to laryngoscopy during propofol anaesthesia. Br J Anaesth. 2006;97:842–7.

    Article  PubMed  CAS  Google Scholar 

  26. Takamatsu I, Ozaki M, Kazama T. Entropy indices vs. the bispectral index™ for estimating nociception during sevoflurane anaesthesia. Br J Anaesth. 2006;96:620–6.

    Article  PubMed  CAS  Google Scholar 

  27. Aho AJ, Yli-Hankala A, Lyytikäinen L-P, Jäntti V. Facial muscle activity, Response Entropy, and State Entropy indices during noxious stimuli in propofol–nitrous oxide or propofol–nitrous oxide–remifentanil anaesthesia without neuromuscular block. Br J Anaesth. 2009;102:227–33.

    Article  PubMed  CAS  Google Scholar 

  28. Driessen JJ, Harbers JBM, van Egmond J, Booij LHDJ. Evaluation of the electroencephalographic bispectral index during fentanyl-midazolam anaesthesia for cardiac surgery. Does it predict haemodynamic responses during endotracheal intubation and sternotomy? Eur J Anaesthesiol. 1999;16:622–7.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Kuopio University Hospital, P.O. Box 1777, 70211, Kuopio, Finland

    Tadeusz Musialowicz MD, Pasi Lahtinen MD, Otto Pitkänen MD, PhD, Jouni Kurola MD, PhD & Ilkka Parviainen MD, PhD

Authors
  1. Tadeusz Musialowicz MD
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  2. Pasi Lahtinen MD
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  3. Otto Pitkänen MD, PhD
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  4. Jouni Kurola MD, PhD
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  5. Ilkka Parviainen MD, PhD
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Corresponding author

Correspondence to Tadeusz Musialowicz MD.

Additional information

Musialowicz T, Lahtinen P, Pitkänen O, Kurola J, Parviainen I. Comparison of Spectral Entropy and BIS VISTA™ monitor during general anesthesia for cardiac surgery.

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Musialowicz, T., Lahtinen, P., Pitkänen, O. et al. Comparison of Spectral Entropy and BIS VISTA™ monitor during general anesthesia for cardiac surgery. J Clin Monit Comput 25, 95–103 (2011). https://doi.org/10.1007/s10877-011-9280-6

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  • DOI: https://doi.org/10.1007/s10877-011-9280-6

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